Class Registration Signup Form

Please be sure to include any children that are younger than school age on your registration form. This includes any children nursery age through age 4.

AT THIS TIME THE FOLLOWING CLASSES ARE CLOSED. YOU MAY REGISTER BUT WILL BE PLACED ON A WAITING LIST - KINDER, 1ST, 2ND, 3RD, 4TH, 5TH, 6TH, 7TH, 8TH, PHYSICAL SCIENCE, WORLD GEOGRAPHY, CHEMISTRY, ALGEBRA 1, ALGEBRA 2, HIGH SCHOOL ENGLISH, ASL 2

Last Name of Family

First Name of Child

Birth Date

MonthDayYear

26-27 Grade

FOR HIGH SCHOOL - First Hour Class: 930-1025

FOR HIGH SCHOOL ONLY - Second Hour Class: 1030-1125

FOR HIGH SCHOOL ONLY - Third Hour Class: 1155-1250

FOR HIGH SCHOOL ONLY - Fourth Hour Class: 1255-150

First Name

Birth Date

MonthDayYear

26-27 Grade

FOR HIGH SCHOOL - First Hour Class: 930-1025

FOR HIGH SCHOOL ONLY - Second Hour Class: 1030-1125

FOR HIGH SCHOOL ONLY - Third Hour Class: 1155-1250

FOR HIGH SCHOOL ONLY - Fourth Hour Class: 1255-150

First Name

Birth Date

MonthDayYear

26-27 Grade

If this child is in high school, please look at the above options for each hour and include the classes you would like him/her to take in the box below.

First Name

Birth Date

MonthDayYear

26-27 Grade

First Name

Birth Date

MonthDayYear

26-27 Grade

First Name

Birth Date

MonthDayYear

26-27 Grade

Parent's Name

FatherMother

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Mobile Number

Area CodePhone Number

Are you able to receive text messages?

Home Phone Number

Area CodePhone Number

What number would you like me to put on the schedule sheet? This will be used by other mothers/fathers who may need to contact you in regards to swapping schedules or class plans.

Other

Who will be fulfilling the role of helping at co-op every other week?

If you would like to discuss the possibility of working every week or not working at co-op (drop off) please make note of that above. All room parent positions must be filled before drop off is an option. Drop off is not included in the listed semester fees. There is an additional fee for that option.

Parent Email

Please make note of any special needs we should be made aware of for your child(ren). This may include allergies, academic needs, or other concerns.

Please list any special gifts or talents you have that you would like to utilize at co-op.

We'd love to have you share at co-op! Do you have any experience in other countries, unique careers, or anything else you think may be enjoyed by the families/children at co-op?

Which age group/area would you like to be involved with on the weeks you are working at co-op? PLEASE NOTE THAT DROP OFF IS NOT AN OPTION UNLESS YOU SPEAK DIRECTLY WITH MINDY. WE ARE UNABLE TO PROVIDE THIS AS AN OPTION UNTIL ALL ROOM PARENTS SLOTS ARE FILLED.

Are you currently CPR and/or first aid certified? (this is not required)

Who (other than the parents) will be able to pick your child(ren) up? This list is not final and can be altered on any particular Friday when you sign your child in.

NEW FAMILIES: How did you hear about us?

RETURNING & NEW FAMILIES: Why do you want to be a part of CHC for the upcoming year?

Please acknowledge each statement below by marking each box.

All activities planned by co-op will be conducted in a safe and orderly manner to the best of our abilities and knowledge (including on site or off site for field trips). However, CHC, nor anyone serving as a representative of CHC accept or implies liability for anyone taking part in the activities. CHC retains the right to decline or discontinue anyone’s participation in any activity at any time at its sole discretion. Normal precautions are always taken to ensure the safety of everyone that is participating. You and/or your child are attending at your own risk and assume all risks on behalf of yourself and your child(ren). You shall release, indemnify, defend, and hold harmless CHC and its representatives from all liability to the fullest extent permissible by law.

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Upon submitting your registration form the director will follow up to either confirm your information or to set up a meeting if you are a new family.